Cardiovascular outcomes after pharmacologic stress myocardial perfusion imaging

被引:4
作者
Lee, Douglas S. [1 ,2 ,3 ,4 ]
Husain, Mansoor [1 ,2 ,3 ,5 ]
Wang, Xuesong [4 ]
Austin, Peter C. [4 ]
Iwanochko, Robert M. [1 ,2 ,3 ]
机构
[1] Univ Toronto, Robert J Burns Nucl Cardiol Lab, Toronto, ON, Canada
[2] Univ Toronto, Univ Hlth Network, Joint Dept Med Imaging, Toronto, ON, Canada
[3] Univ Toronto, Univ Hlth Network, Peter Munk Cardiac Ctr, Toronto, ON, Canada
[4] Univ Toronto, Inst Clin Evaluat Sci, Toronto, ON, Canada
[5] Univ Toronto, Ted Rogers Ctr Heart Res, Toronto, ON, Canada
基金
加拿大健康研究院;
关键词
CORONARY-ARTERY-DISEASE; EMISSION COMPUTED-TOMOGRAPHY; INCREMENTAL PROGNOSTIC VALUE; MEDICAL THERAPY; HEART-FAILURE; RISK STRATIFICATION; COST-EFFECTIVENESS; CT ANGIOGRAPHY; REVASCULARIZATION; IMPACT;
D O I
10.1016/j.ahj.2016.01.012
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background While pharmacologic stress single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is used for noninvasive evaluation of patients who are unable to perform treadmill exercise, its impact on net reclassification improvement (NRI) of prognosis is unknown. Methods We evaluated the prognostic value of pharmacologic stress MPI for prediction of cardiovascular death or nonfatal myocardial infarction (MI) within 1 year at a single-center, university-based laboratory. We examined continuous and categorical NRI of pharmacologic SPECT-MPI for prediction of outcomes beyond clinical factors alone. Results Six thousand two hundred forty patients (median age 66 years [IQR 56-74], 3466 men) were studied and followed for 5963 person-years. SPECT-MPI variables associated with increased risk of cardiovascular death or non-fatal MI included summed stress score, stress ST-shift, and post-stress resting left ventricular ejection fraction <= 50%. Compared to a clinical model which included age, sex, cardiovascular disease, risk factors, and medications, model chi(2) (210.5 vs. 281.9, P < .001) and c-statistic (0.74 vs. 0.78, P < .001) were significantly increased by addition of SPECT-MPI predictors (summed stress score, stress ST-shift and stress resting left ventricular ejection fraction). SPECT-MPI predictors increased continuous NRI by 49.4% (P < .001), reclassifying 66.5% of patients as lower risk and 32.8% as higher risk of cardiovascular death or non-fatal MI. Addition of MPI predictors to clinical factors using risk categories, defined as <1%, 1% to 3%, and >3% annualized risk of cardiovascular death or non-fatal MI, yielded a 15.0% improvement in NRI (95% CI 7.6%-27.6%, P < .001). Conclusions Pharmacologic stress MPI substantially improved net reclassification of cardiovascular death or MI risk beyond that afforded by clinical factors.
引用
收藏
页码:138 / 146
页数:9
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